ASPO Abstracts
Disparities in never-smoking lung cancer risk across Asian American, Native Hawaiian, and other Pacific Islander female groups within a multilevel integrated dataset of EHR data and cancer registry data
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
There has been no single sufficiently-large data source to document lung cancer risk by smoking status and sex among specific Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) groups, which is central to understanding and reducing the burden of this disease in these populations. We assembled a large cohort to quantify the burden of lung cancer by smoking status among six single- and multi-ethnic AANHPI groups.
To assemble the cohort, we harmonized and pooled electronic health record (EHR) data (including race/ethnicity and smoking) from two large health systems (i.e., Northern California Sutter Health system and Kaiser Permanente Hawaii (KPH)) and linked tumor and diagnosis data from the respective state cancer registries. Age-adjusted incidence rates (AAIR) stratified by sex, detailed race/ethnicity, smoking status, and lung cancer histology were calculated, as well as incidence rate ratios (IRRs) by race/ethnicity.
The cohort comprises over 2.3 million individuals (250,000 AANHPI females) followed up to 13 years for incident lung cancer. It includes over 6,000 incident lung cancer cases (558 AANHPI females). With the exception of Japanese females, risk of never-smoking lung cancer was higher among all female single and multi-ethnic AANHPI groups (IRRs ranging from 1.66 among Native Hawaiian to 2.26 among Chinese females) compared to non-Hispanic White females. Rates were highest among Chinese females (AAIR, 22.8 per 100,000) and Asian females reporting multiple races/ethnicities (AAIR, 22.2). Nearly 80% of Chinese females with lung cancer had never smoked.
This is the first study to document the disproportionately high burden of never-smoking lung cancer among AANHPI female groups. Ongoing work will include longitudinal analyses of lung cancer risk among never-smoking AANHPI females, including absolute risk modeling to examine five exposure domains representing known and putative lung cancer risk factors (i.e., previous lung diseases; infectious disease; body size; reproductive factors; and neighborhood factors, including air pollution). Results from this work will serve as a critical evidence base to inform screening, research, and public health priorities, especially among AANHPI females.
Keywords: Never-smoking lung cancer; Asian American, Native Hawai'ian, and other Pacific Islanders; Cancer disparities; electronic health records